Q: Can ingestion of a steroid cream be equivalent to ingested prednisone for acute asthma or anaphylaxis?

Posted on January 6, 2010 by & filed under , , .

Q: I understand the steroids (e.g., prednisone) can sometimes be helpful in managing allergic reactions and asthma and that their use is part of your protocols for those conditions. If there was nothing else available, would ingestion of a steroid cream be a suitable and effective alternative for prednisone?

After spending some time and given the resources I have at hand, I cannot give you a satisfactorily accurate answer.

Hydrocortisone is available in a pill form and is used particularly by people whose adrenal glands are absent or not functioning properly. In this form it is rapidly absorbed in the gut. 4 mg of hydrocortisone equals 1 mg of prednisone.

Hydrocortisone is sold for topical use (on the skin) either as 0.5 or 1% creams or ointments. 1 gm of 1% topical hydrocortisone is equal to 10 mg of hydrocortisone. That would give you nearly 300 mg in a 1 ounce/30 gm tube or, theoretically, the equivalent of 75 mg of prednisone. What I don’t know and what I was unable to find out easily is what happens to hydrocortisone topicals on ingestion. The cream is water soluble so, at least theoretically, it is more easily absorbed in the gut than the ointment. In addition, I could not find any pharmacokinetic (movement of a drug through the body) data about rates of absorption from the gut or subsequent blood levels and I have no idea what happens with either when exposed to digestive enzymes. Aside from nausea and vomiting or diarrhea, the poison control literature suggests that a mouthful is not likely to be toxic.

So yes, theoretically, it could help but any potential effect would be unpredictable. By the way, a tube cost about 5$US; thirty 20 mg tablets of prednisone tablets are less than 10$US. I think you know what I would choose.

One Response to “Q: Can ingestion of a steroid cream be equivalent to ingested prednisone for acute asthma or anaphylaxis?”

Topical Corticosteroids, in any of the currently available forms to treat allergic diseases (skin topicals, nasal corticosteroid sprays for treatment of allergic rhinitis or inhaled corticoids for asthma, i.e. Advair or Symbicort), are by definition not systemically active in current dosage forms. They (the topical skin agents in particular) are not designed or have been shown in any of the clinical trials to be systemically active , if ingested. Nor is absorption thru nasal or bronchial epithelial lining effective enough to be to show any systemic or clinical benefit. This is because enough cannot reach the bloodstream through these portals, but more importantly any drug that is absorbed is rapidly degraded by the liver and the active metabolites are not designed to be clinically active.
Slurping down a tube of Cortaid (1% hydrocortisone OTC) may give you an upset stomach but won’t help your allergies. The only topical corticosteroid to have shown systemic effects was Decadron Turbinaire spray, for the nose, long since discontinued. Ultra-high potency corticosteroid creams for eczema in infants or children, however, are best avoided for reasons shown below.

In infants with atopic dermatitis (allergic eczema), especially if the skin is excoriated or actively inflammed, it has been shown that some corticosteroid may be absorbed (due to the small surface area and open skin).
But almost all experts agree that it is essentially clinically negligible and irrelevant.
As a double board-certified physician in Internal Medicine and Allergy/Clinical immunology trained at Northwestern University in Chicago with 19 years of treating patients, I have not seen in any of my patients benefit of a topical in any form, over a parental form, i.e. Prednisone, IM Kenalog, IM Depo-Medrol, or oral Methyprednisolone, (“Medrol Dose Pack”).
But these meds are safe in short bursts. The Adrenal Cortex produces on a daily basis 7.5mg of prednisolone equivilent, so a short 6 day tapering dose of Prednisone or Medrol is virtually side effect free and systemic effects of relevance are negligable and by and large these parenteral or systemic forms are very well-tolerated.
Great question, something my patients ask about frequently.
Thanks
Mike Ganz M.D.

David Johnson, MD

In addition to his writing, teaching, and business responsibilities with Wilderness Medical Associates, David (DJ) also works as an Emergency Physician at Central Maine Medical Center in Lewiston, Maine His outdoor pursuits have included wilderness...